General Surgery

General Surgeries focus on areas including the abdominal intestines, stomach, esophagus, liver, small bowl, colon, bile ducts, thyroid gland and pancreas. Emirates Hospital being a state of the art institution offers clients the best General Surgery Dubai. For years we have rendered our expert professionals to millions of patients across the Middle East. If you are in need of medical help then trust us with your problem, we promise, we won’t let you down.

Our surgeons render services for all sorts of non cosmetic breast surgery, especially pertaining to diagnosis of breast cancer. Wait, as there is still more, clients can also be assisted with medical facilities for GI bleeding, gastrectomy, gallbladder removal, Diaphragmatic Hernia Repair and hiatal hernia repair. Our renowned surgeons can deal with all sorts of surgeries related to the torso.

Colon or the large intestine is the last portion of the intestinal tract where water is absorbed and waste material is stored temporarily. Our doctors recommend a colon surgery when tumors on the colon are detected. The surgery is performed with utmost efficiency allowing patients to recover within a time span of four to six weeks.

Hemorrhoidal and other non-rectal problems have plagued the human species the origin of our species, but the good news is that with the advent of modern technology and advancements in medical science we can now counter these problems. Contact our surgeons at Emirates Hospital and consult them in case you feel anal pain or bleeding. Trust us for all types of General surgery as we guarantee you hundred percent satisfaction. We are just a call away!

Same Day Surgery

At the Emirates Hospital’s Same Day Surgery unit, the special needs of many surgery patients may be met in one day in a home-like atmosphere, with personal attention and lower prices than inpatient surgery. Emirates Hospital offers the protective back-up of the full services of an acute care hospital. Our anesthesia team and nurses are experts at same day surgery. Most surgical specialties are available including Gynecology, cosmetic surgery, General Surgery, Ear Nose and Throat, Pediatric Surgery, Urology and Eye Surgery.

We do not admit patients for chronic illnesses, renal dialysis, cancer radiation therapy, brain surgery, open heart surgery, deliver babies or treat victims of car accidents or those who need prolonged rehabilitation. These conditions are best served at a general hospital. This separation allows our surgical hospital to focus on elective surgery performed on otherwise healthy patients.

Emirates Hospital offers many of the services you’d expect to find at a state-of-the-art medical institution, such as the advanced technology that makes Same Day Surgery such a convenient and more pleasant option for so many patients. We specialize in Minimally Invasive Procedures, so recovery time and discomfort are minimal. The well-trained members of our nursing staff ensure that you get the best possible care, no matter how long you stay stay with us.

Our Same Day Surgery Center offers convenient underground parking, an open waiting area and volunteers who specialize in helping patients. We work hard to meet your every need as a patient or family member.

With Emirates Hospital’s Same Day Surgery unit, the special needs of many surgery patients may be met in one day, with personal attention and lower prices than inpatient surgery.

Consider these advantages in Selecting Same Day Surgery in preference to inpatient surgery:

Patient Safety
Emirates Hospital offers the protective back-up with the full services of an acute care hospital.

Convenience
The Same Day Surgery unit is conveniently located on the hospital’s main floor near the admitting office, laboratory, X-ray, surgery and emergency services.

Personal Attention by Caring Professionals
Patients are escorted to the comfortable, home-like atmosphere of the Same Day Surgery unit where a caring, professional nurse assists the patient to prepare for surgery. The Same Day Surgery nurse and the nurse from surgery are available to answer any questions the patient may have as well as to provide calm reassurance.

After the surgical procedure is performed in the adjoining surgical suite, the patient is taken to the post-anesthesia care unit until awake. The patient then returns to the same relaxing atmosphere of low lights and soft music of the Same Day Surgery unit to recline for an hour or so.

When the patient is able to return home, the nurse reviews follow-up instructions and gives a folder of helpful materials and written instructions to the patient, who is then discharged to recuperate in the familiar surroundings of home.

Visitors Are Welcome
The staff at Emirates Hospital wish to extend a warm welcome to the families and friends of our patients. We realize that your love, support and encouragement are an integral part of the healing process. Regular visiting hours are from 11:00 a.m. to 8:30 p.m.

Colonoscopy

Colon cancer is the second leading cause of cancer death after luncg cancer. Routine colonoscopy can detect early colon cancer which is curable in 90% of the time.

Colonoscopy (koh-luh-NAH-skuh-pee) lets the physician look inside your entire large intestine, from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine. The procedure is used to diagnose the causes of unexplained changes in bowel habits. It is also used to look for early signs of cancer in the colon and rectum. Colonoscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, bleeding, and muscle spasms.

WHO SHOULD HAVE A COLONOSCOPY?

Your physician may recommend a colonoscopy exam if you have change in bowel habit or bleeding, indicating a possible problem in the colon or rectum. A colonoscopy is also necessary to:

Check unexplained abdominal symptoms

Check inflammatory bowel disease (colitis)

Verify findings of polyps or tumors located with a barium enema exam

Examine patients who test positive for blood in the stool

Monitor patients with a past history of colon polyps or cancer

HOW IS COLONOSCOPY PERFORMED?

The bowel must first be thoroughly cleared of all residue before a colonoscopy. This is done one to two days before the exam as prescribed by your physician.

For the procedure, you will lie on your left side on the examining table. You will probably be given pain medication and a mild sedative to keep you comfortable and to help you relax during the exam. The physician will insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope (koh-LON-oh-skope). The scope transmits an image of the inside of the colon, so the physician can carefully examine the lining of the colon. The scope bends, so the physician can move it around the curves of your colon. You may be asked to change position occasionally to help the physician move the scope. The scope also blows air into your colon, which inflates the colon and helps the physician see better.

The colonoscope is inserted and when possible will be advanced to the portion of the colon where the small intestine enters. During a complete examination of the bowel, your physician will remove polyps or take biopsies as necessary.

If anything unusual is in your colon, like a polyp or inflamed tissue, the physician can remove a piece of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the physician can pass a laser, heater probe, or electrical probe, or inject special medicines, through the scope and use it to stop the bleeding.

Bleeding and puncture of the colon are possible complications of colonoscopy. However, such complications are uncommon.
Colonoscopy takes 30 to 60 minutes. The sedative and pain medicine should keep you from feeling much discomfort during the exam. You will need to remain at the physician’s office for 1 to 2 hours until the sedative wears off.

PREPARATION

Your colon must be completely empty for the colonoscopy to be thorough and safe. To prepare for the procedure you may have to follow a liquid diet for 1 to 3 days beforehand. A liquid diet means fat-free bouillon or broth, Jell-O®, strained fruit juice, water, plain coffee, plain tea, or diet soda. You may need to take laxatives or an enema before the procedure. Also, you must arrange for someone to take you home afterward–you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.

The entire procedure usually takes less than an hour. There is little pain; however, mild sedation is given when necessary to relieve anxiety and discomfort. Following the colonoscopy, there may be slight discomfort, which quickly improves with the expelling of gas. Most patients can resume their regular diet later that day.

WHAT ARE THE BENEFITS OF COLONOSCOPY?

With colonoscopy, it is now possible to detect and remove most polyps without abdominal surgery. Colonoscopy is more accurate than an x-ray exam of the colon to detect polyps or early cancer. Frequently, polyps can be removed at the same time, a major step towards the prevention of colon cancer.

Endoscopic Surgery

If your doctor has recommended endoscopy . . .

Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see images of the body’s internal structures through very small incisions.

Endoscopic surgery has been used for decades in a number of different procedures, including gallbladder removal and knee surgery and plastic surgery instruments have recently been introduced. Plastic surgeons believe the technique holds great promise.

The endoscope
An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and a bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body’s internal structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the surgical area.

It’s important to understand that the endoscope functions as a viewing device only. To perform the surgery, a separate surgical instrument–such as a scalpel, scissors, or forceps–must be inserted through a different point of entry and manipulated within the tissue.

Advantages of endoscopy
All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, your scars are likely to be hidden, much smaller and some of the after effects of surgery may be minimized.

In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For others, such as a banding or gallbladder usrgery, three or more short incisions may be needed. The tiny “eye” of the endoscope’s camera allows a surgeon to view the surgical site almost clearly as if the skin were opened from a long incision.

Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also, bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, you may recover more quickly and return to work earlier than if you had undergone open surgery.

Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation. Be sure to discuss this possibility with your doctor.

In endoscopic surgery, a probe with a tiny camera transmits images inside the body to a video monitor.

And, keep in mind that if a complication occurs at any time during the operation your surgeon may have to switch to an open procedure, which will result in a more extensive scar and a longer recovery period. However, to date, such complications are rare–estimated to occur in less that 5 percent of all endoscopy procedures.

Our Equipment
Our three dimensional camera and high resolution monitors represent the latest advances in endoscopic technology enhancing your chances of achieving the best results.

Laparoscopic Procedures

Endourologists at Emirates Hospital are leaders in the field of minimally invasive surgery. Patients who have undergone a minimally invasive procedure at Emirates Hospital often go home same day or the next day. These patients need less pain medication after surgery; have less blood loss during surgery; have a low infection rate; and are up around and back to normal activities more quickly than with conventional surgery.

A variety of conditions can be treated in this fashion including patients with kidney stones, urinary incontinence, benign prostatic hyperplasia, and renal tumors. Ureteroscopy, the most advanced and latest shock wave lithotripsy combined with ultrasound therapy, and the entire range of laparoscopic surgery in urology is performed here including adrenalectomy, simple and radical nephrectomy and urinary incontinence surgery.

Pelvic organs, including the bladder, uterus, bowel and rectum are supported by strong, elastic, mesh-like tissue called endopelvic fascia and pelvic floor muscles called levators. When these support structures are strained or weakened, some or all of the above mentioned organs may sag. Such drooping occurs mainly into or through the vaginal space. This process can cause a variety of symptoms, including vaginal bulging/fullness, pelvic pressure/pain, urinary and/or fecal incontinence and more.

Pelvic floor exercises, including biofeedback and electrical stimulation may help patients with mild pelvic floor relaxation. Moderate or severe pelvic floor dysfunction is usually treated surgically. Patients with high surgical risk (heart, lung or other serious illnesses) may get partial relief using vaginal pessary.

Traditional surgical approaches require a several inch long abdominal incision, a two to three day hospital stay and a six week recovery period. The majority of repairs can be accomplished vaginally, with a shorter, one to two day hospital stay and about a four week recuperation phase.

Laparoscopic restoration of pelvic floor is an outpatient surgery requiring only a two week recovery period. A high level of knowledge in laparoscopic surgery is necessary to perform these procedures.

Paravaginal Repair and Vaginal Cuff Suspension are two of the main surgeries which are done to correct pelvic floor relaxation. Both operations can be accomplished using abdominal, vaginal or laparoscopic approach.

Burch Colposuspension is one of the main operations which is used to repair stress urinary incontinence. It can be completed abdominally or via laparoscope.

Laparoscopic procedures are performed using minimally invasive techniques. Three tiny incisions are required: a third of an inch naval access and two or three abdominal openings which are each a fifth of an inch long. Employing zoom cameras, special instruments and permanent sutures the sagging pelvic tissues are transfixed and brought back to their normal anatomic position.

Laparoscopic restoration of continence and elimination of vaginal pressure/bulge generate maximal restitution of quality of life with minimal hospital stay and recovery time.

Spleen removal

The spleen is an organ involved in the production and maintenance of red blood cells, the production of certain circulating white blood cells, as a part of the lymph system, and as a part of the immune system.

General anesthesia is used. The patient is in deep sleep and pain free. The surgeon makes an incision in the abdomen.

The surgeon locates and isolates the spleen, rotates it and brings it out of the wound. Its attachments to other organs are gently cut. In children, following traumatic injury and splenic disruption, a healthy fragment of the spleen may be reimplanted. Such fragments provide continued splenic function.

The outcome varies with the underlying disease and extent of other injuries. Complete recovery from surgery should be anticipated. Recovery from the operation should be rapid. Hospitalization should be less than a week, and complete healing should occur within 3 to 4 weeks.

Small Bowel Resection

The small intestine absorbs much of the liquid and nutrients from food. The small intestine is made up of the duodenum, jejunum, and ileum.

Resection of the small bowel is performed to correct: blockage of the intestine (intestinal obstruction) due to scar tissue or deformities bleeding, infection, or ulcers due to inflammation of the small intestine (regional ileitis, regional enteritis, or Crohn’s disease) injuries cancer precancerous polyps.

While you are deep asleep and pain-free (using general anesthesia), an incision is made in the abdomen.

The diseased part of the small intestine (ileum) is removed. The two healthy ends are either stapled or sewn back together, and the incision is closed. If it is necessary to spare the intestine from its normal digestive work while it heals, a temporary opening (stoma) of the intestine into the abdomen (ileostomy) is made. The ileostomy is later closed and repaired. In some cases, ileostomies are permanent. The ileum absorbs much of its fluid from food. When the large intestine is bypassed by an ileostomy, expect liquid stool (feces). The frequent drainage of liquid stool usually causes the skin around the ileostomy to become inflamed. Careful skin care and a well-fitting ileostomy bag reduce this irritation.

The outcome of your surgery depends on the disease. Most patients stay in the hospital for five to seven days. Complete recovery from surgery may take two months. Eating is restricted during the first few days after surgery.

Pelvic Laparoscopy

The female reproductive organs are in the pelvis. The fallopian tubes connect the ovaries to the uterus.

Pelvic Laparoscopy is used both for diagnosis and for treatment and may be recommended for pelvic pain due to:

uterine tissue found outside the uterus in the abdomen (endometriosis)

puncture through the uterus (uterine perforation) following D&C or by IUD

evaluation of a pelvic mass (such as in a Fallopian tube or ovary) that was confirmed previously by abdominal ultrasound

While the patient is deep asleep and pain-free (general anesthesia), a one-half inch incision is made in the skin below the navel (umbilicus).

Air is pumped into the abdomen to make the organs of the abdominal cavity more easily visible. The laparoscope is inserted and the area can be viewed. Instruments can be inserted through the scope to obtain tissue samples or to perform certain surgical procedures. After the laparoscopy, the gas is released and the incision is stitched.

Patients are usually able to go home within 24 hours of surgery. Results depend on the procedure performed and the disease present.

Pancreatitis

The pancreas is located posterior to the abdomen. It contains cells that secrete the hormone insulin, and cells that secrete digestive enzymes that aid in the breakdown of food in the gastrointestinal tract. The pancreas secretes these enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.

Inflammation of the pancreas, or pancreatitis, is a serious condition that is most commonly caused by either alcohol toxicity or gallstones. Gallstones can lodge in the common bile duct and block the flow of pancreatic enzymes out of the pancreas into the intestine. Pancreatitis due to alcohol toxicity is most often seen in chronic alcoholic patients. Most often, pancreatitis goes away with nonsurgical therapy. The patient will not be allowed to eat for three to five days, to prevent secretion of enzymes by the pancreas. He will also receive pain medication to control the pain caused by pancreatic inflammation.

If pancreatitis is due to gallstones, most often the responsible gallstone passes into the intestine spontaneously, and the pancreatitis goes away. Less commonly, a minor surgical procedure is necessary to extract a gallstone that is blocking the pancreatic duct where it drains into the small intestine. An endoscope, with a camera on its end, is passed down the esophagus, through the stomach, and into the small intestine. The entrance of the pancreatic duct into the small intestine can be viewed through the endoscope. A special instrument on the end of the endoscope can then be passed into the pancreatic duct and the gallstone is extracted. Very rarely pancreatitis is severe enough to require surgery, which is usually performed when the pancreas becomes infected. Dead pancreatic tissue is removed, and the area around the pancreas is washed clean. Patients who require such treatment usually have prolonged hospital stays and are seriously ill.

Breast Cancer

Breast cancer begins in the breast and spreads first to the lymph nodes of the armpit (axilla). When a breast lump is found to contain cancer, and if the cancer has not spread beyond the nodes of the axilla to distant sites, it is often removed surgically.

In many cases of breast cancer, removal of the entire breast is unnecessary. Removal of only a small lump of tissue containing the cancer (lumpectomy) along with the nodes that drain the breast (axillary node dissection), followed by radiation therapy to the breast, is all that is required.

Large Bowel Resection

The large bowel [large intestine or the colon] is part of the digestive system. It runs from the small intestine to the rectum. It is made up of three portions; the ascending, transverse and descending colon. The ascending colon is sometimes referred to as the right colon; the descending colon is sometimes referred to as the left, or sigmoid colon.

Bowel resection may be indicated for: blockage of the intestine (intestinal obstruction) due to scar tissue or tumors bleeding, due to diverticulosis or arteriovenous malformations injuries cancer precancerous polyps familial polyposis infection, due to diverticulitis.

The patient is deep asleep and pain-free (general anesthesia). A lower midline incision is made in the abdomen. Sometimes, the surgeon will use a lateral lower transverse incision instead.

The diseased part of the large intestine (colon) is removed. The two healthy ends are then sewn or stapled back together and the incision is closed. A stapling procedure is shown here.

If it is necessary to spare the intestine from its normal digestive work while it heals, a temporary opening of the intestine onto the abdomen (colostomy) may be done. A temporary colostomy will be closed and repaired later. If a large portion of the bowel is removed, the colostomy may be permanent. The large intestine (colon) absorbs most of the fluid from foods. When the colon is bypassed by a colostomy in the right colon, the colostomy output is generally liquid stool (feces). If the colon is bypassed in the left colon, the colostomy output is generally more solid stool. The constant or frequent drainage of liquid stool can cause the skin around the colostomy to become inflamed. Careful skin care and a well-fitting colostomy bag can reduce this irritation.

Most patients will stay in the hospital for 5 to 7 days. Complete recovery from surgery may take 2 months. During the first few days after surgery, eating is restricted.

Laparoscopic surgery

Laparoscopic surgery is a surgical technique in which short, narrow tubes (trochars) are inserted into the abdomen through small (less than one centimeter) incisions. Through these trochars, long, narrow instruments are inserted. The surgeon uses these instruments to manipulate, cut, and sew tissue.

Carbon dioxide gas is infused through one of the trochars into the patient’s abdomen. This pushes the anterior abdominal wall upward, and makes room for the surgeon to work. A camera, inserted through one trochar, is linked to a video monitor. This allows the surgeon to view the abdominal contents.

Clamps, scissors, and sutures on the end of long, narrow instruments are inserted through the other trochar.

A number of different procedures can be performed laparoscopically, including gallbladder removal (laparoscopic cholecystectomy), esophageal surgery (laparoscopic fundoplication), colon surgery (laparoscopic colectomy), and surgery on the stomach and spleen. One advantage of laparoscopic surgery is that patients recover much more quickly than they do from standard surgery.

Inguinal Hernia Repair

Vessels that provide blood to the testicle exit the abdomen through a hole in the abdominal wall (inguinal ring). In women, this ring is also present, despite the absence of testicular vessels. In normal cases, the inguinal ring is small enough to prevent the passage of abdominal contents (such as the small or large intestines) outside of the abdominal cavity.

A hernia exists when the inguinal ring enlarges to the point where a bowel can pass through it. Hernias most often cause pain in the groin. Often, a lump is felt in the groin area. This lump represents a bowel passing through the inguinal ring. In most cases, the bowel is able to re-enter the abdomen on its own. Less frequently, the bowel becomes trapped outside of the abdomen, leading to an incarcerated hernia. All inguinal hernias must be repaired. If not, a bowel passing through the inguinal ring becomes trapped and deprived of blood flow, leading to a strangulated hernia.

While you are awake and pain-free (using local anesthesia or spinal anesthesia) or asleep and pain-free (using general anesthesia), an incision is made over the hernia. The bulging tissue or organ is replaced inside of the muscle wall; the muscle tissue is repaired; and the skin is closed. Frequently, a small piece of synthetic mesh is used to close the defect in the inguinal ring. Less commonly, laparoscopic surgical techniques are used to repair ingunial hernias.

Moving and walking are recommended the day of surgery. Small children do not require any restriction following a routine hernia repair. However, older children should avoid body-contact sports for at least three weeks because a blow to the incision could burst the skin closure. Expect complete recovery from surgery in about two to four weeks. Avoid heavy lifting or straining for several weeks after surgery. Avoid bathing for at least five days after the operation since soaking separates the skin tapes, and the wound could break open. Sponge bathing for infants and showering for older children are permitted the day after surgery. Remember to carefully pat dry the wound tapes after showering.

Inflammatory Bowel Disease

The gastrointestinal tract starts at the mouth, which leads to the esophagus, stomach, small intestine, colon, and finally, the rectum and anus. The GI tract is basically a long, hollow, muscular tube through which food passes and nutrients are absorbed.

Inflammatory bowel disease is a condition in which the inner lining of the GI tract becomes inflamed, leading to ulcers and bleeding. The colon is most often the site of this inflammation.

Patients with inflammatory bowel disease have symptoms that include diarrhea, abdominal pain, infections, and bleeding. Inflammatory bowel disease falls under two main headings: Crohn’s disease, which involves the entire GI tract, and ulcerative colitis, which involves only the colon. The cause of Inflammatory Bowel Disease is unknown.

The primary treatment for Inflammatory bowel disease involves medications, such as steroids, which can decrease inflammation and resolve symptoms.

Occasionally, if segments of bowel are very inflamed and are not responding to medication, surgery to remove these segments may be necessary.

While the patient is deep asleep and pain-free (general anesthesia), an incision is made in the midline of the abdomen.

The inflamed segment of the colon or small intestine is removed and the healthy ends are sewn back together.

The removal of one section does not preclude recurrence of symptoms in other areas of the intestine. The course of inflammatory bowel disease is often variable: Some patients experience only mild symptoms, while others have more debilitating symptoms

Hiatal Hernia Repair

The esophagus runs through the diaphragm to the stomach.

When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-esophageal reflux: GER) as gastric acid backflows from the stomach into the esophagus. Hiatal Hernia Repair is surgery to repair a bulging of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia). Hiatal hernia repair may be recommended when the patient has: severe heartburn severe inflammation of the esophagus from the backflow of gastric fluid (reflux) narrowing of the opening (hiatus) through the diaphragm (esophageal stricture) chronic inflammation of the lungs (pneumonia) from frequent breathing in (aspiration) of gastric fluids.

While the patient is deep asleep and pain-free (general anesthesia), an incision is made in the abdomen.

The stomach and lower esophagus are placed back into the abdominal cavity. The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce reflux.

Patients may need to spend 3 to 10 days in the hospital after surgery. A tube will be placed into the stomach through the nose and throat (nasogastric tube) during surgery and may remain for a few days. Small, frequent feedings are recommended.

Hemorrhoid Surgery

The rectum is the final portion of the large intestine. It empties stool from the body through the anus. Hemorrhoids are “cushions” of tissue filled with blood vessels at the junction of the rectum and the anus. These cushions normally act to prevent the leakage of stool from the anus. These vascular cushions can become swollen and inflamed, usually due to increased intra-abdominal pressure, such as straining when constipated or during pregnancy. Such swelling causes pain, bleeding, and itching.

The hemorrhoid is bound (ligated) at the base to prevent bleeding from blood vessels within it. Then it is removed surgically. Some surgeons simply apply a rubber band around the base of the hemorrhoid (banding), depriving it of its blood supply. The hemorrhoid will then simply fall off and be passed into the stool. Some surgeons inject the base of the hemorrhoid with a sclerosing agent (sclerotherapy), which also destroys the vessels in the hemorrhoid, causing it to fall off and be passed into the stool. More than 90% of hemorrhoid cases are successful. There is considerable pain after surgery as the anus tightens and relaxes, but medications are available to alleviate this. To avoid straining, stool softeners are used. Avoid any straining during bowel movement or urination. Soaking in a warm bath also provides additional comfort. Expect complete recovery in about two weeks.

GI Bleeding

The gastrointestinal tract starts at the mouth, which leads to the esophagus, stomach, small intestine, colon, and finally, the rectum and anus. The GI tract is a long, hollow, muscular tube through which food passes and nutrients are absorbed.

Bleeding from the GI tract is a common medical problem. Patients usually notice either dark red blood or bright red blood in their stool. Ulcers of the stomach and duodenum are common causes of bleeding from the upper GI tract. Bleeding can also occur in the lower GI tract (colon). Diverticular bleeding is a common cause of lower GI bleeding.

The first step in the treatment of GI bleeding is to locate the source of the bleeding. Patients who have lost significant amounts of blood are transfused with blood. Next, an endoscope is used to locate the source of the bleeding. Upper endoscopy is generally performed first, and if no bleeding source is located, then lower endoscopy is performed. During an endoscopy, the patient is usually sedated but awake.

In many cases, GI bleeding will stop on its own, with no treatment. In other cases, treatment can be provided with the endoscope, most often in the form of cautery (electrocoagulation) of the site of bleeding.

If the bleeding cannot be stopped using the endoscope, surgery may be required. The bleeding segment of intestine or stomach is removed. However, most cases of GI bleeding are managed successfully with endsocopy.

Gastroesophageal Reflux

The esophagus is a narrow, muscular tube that leads from the mouth to the stomach. The esophagus carries food from the mouth to the stomach. A sphincter at the junction of the esophagus and the stomach prevents reflux of food and acid from the stomach into the esophagus.

When the lower esophageal sphincter doesn’t function properly, acid and food can reflux up from the stomach into the esophagus. This can lead to pain (heartburn) and damage to the lower esophagus. This damage can cause strictures (narrowing) of the esophagus, and eventually, cancer of the esophagus. Frequently, dysfunction of the lower esophageal sphincter is associated with a hiatal hernia, in which the lower esophagus and upper part of the stomach slips up into the chest.

The first step in managing esophageal reflux disease involves medical treament. Anti-acid medications can neutralize acid that refluxes into the esophagus and prevent damage to the eophagus. If these medications do not eliminate symptoms, surgery may be necessary. The primary surgical treatment of esophageal reflux is called esophageal fundoplication. Fundoplication can be performed through an upper midline incision, or using a laparoscopic procedure.

Currently, the laparoscopic procedure is being performed more frequently. Long narrow instruments are passed through small incisions in the abdomen, and the surgery is viewed using a long narrow camera passed through one of these incisions.

There are a number of different types of fundoplication procedures, which all involve wrapping a part of the upper stomach around the esophagus and re-creating the lower esophageal sphincter. The most commonly performed fundoplication procedure is called Nissen’s fundoplication. Fundoplication generally has excellent results, and cures reflux disease without the need for life-long anti-acid medications.

Gastrectomy

The stomach connects the esophagus to the small intestine, and functions to break up food into small particles that can be absorbed by the small intestine.

In cases of chronic stomach problems (such as ulcers), obesity or cancer, partial or total removal of the stomach may be indicated. An incision is made in the skin over the pyloric region of the stomach. The diseased portion of the stomach is removed. The small intestine is attached to the remainder of the stomach to maintain the integrity of the digestive tract.

The patient will be on nasograstric tube suction to keep the stomach empty and at rest after surgery. After several days and when the stomach starts to function normally again the tube will be removed and the patient will begin ingesting clear liquids and gradually progress to a full and normal diet.

Gallbladder Removal

The gallbladder is located inside the right side of the abdomen, underneath the liver. It stores bile that is produced by the liver, and delivers it to the first part of the small intestine (duodenum), where it aids in the digestion of fat. The cystic ducts and common bile ducts connect the gallbladder to the duodenum, and allow bile to pass through.

Gallbladder surgery is performed to treat gallbladder disease, which mainly consists of the formation of gallstones in the gallbladder (cholelithiasis). Gallstones cause: obstruction of the cystic duct leading to severe abdominal pain (biliary colic) infection or inflammation of the gallbladder (cholecystitis) blockage of the biliary ducts leading to the duodenum (biliary obstruction) In each case, removal of the gallbladder (cholecystectomy) is necessary.

Most gallbladder surgery performed today entails laparoscopic surgical techniques, in which narrow instruments, including a camera, are introduced into the abdomen through small puncture holes. If the procedure is expected to be straightforward, laparoscopic cholecystectomy is used. A laparoscopic camera is inserted into the abdomen near the umbilicus (navel). Instruments are then inserted through two or more small puncture holes. The gallbladder is found, the vessels and tubes are cut, and the gallbladder is removed.

If the gallbladder is extremely inflamed, infected, or has large gallstones, the abdominal approach (open cholecystectomy) is recommended. A small incision is made just below the rib cage, on the right side of the abdomen. The liver is then moved to expose the gallbladder. The vessels and tubes (cystic duct and artery) connected to the gallbladder are cut, and the gallbladder is removed. The tube (common bile duct) that drains the digestive fluid (bile) from the liver to the small intestine is examined for blockages or stones. If there is inflammation or infection, a small, flat tube is left inside for several days to drain out fluids.

Most patients who undergo laparoscopic cholecystectomy go home the day of surgery. They immediately resume a normal diet and normal activities. Most patients who undergo open cholecystectomy require five to seven days of hospitalization. They resume a normal diet after one week, and normal activities after four to six weeks.

ERCP

The stomach leads to the first part of the small intestine, also called the duodenum. The common bile duct carries bile from the liver to the duodenum, and enters the duodenum a few centimeters beyond the stomach.

Gallstones usually form in the gallbladder. Gallstones sometimes pass from the gallbladder into the common bile duct, and block the flow of bile into the duodenum. This can result in serious illness. Additionally, tumors of the pancreas and duodenum can block the bile duct, also preventing the flow of bile into the duodenum.

If gallstones are present in the common bile duct, the surgeon can perform a sphincterotomy. A small incision is made through the endoscope, which enlarges the opening of the common bile duct into the duodenum. The stones can then pass through.

If a tumor is present and constricting the bile duct, a plastic or metal stent can be placed into the bile duct, thus holding it open, and allowing bile to pass through.

Diaphragmatic Hernia Repair

The chest cavity includes the heart and lungs. The abdominal cavity includes the liver, stomach, and small and large intestines. These two regions are separated by the diaphragm, which is a large, dome-shaped muscle.

When the diaphragm develops with a hole in it, the abdominal organs can pass into the chest cavity. The lung tissue on the affected side is compressed, fails to grow normally, and is unable to expand after birth. As the baby begins to breathe, cry, and swallow, air enters the intestines that are protruding into his chest. The increasing size of the baby’s intestines puts pressure on the other side of his chest, lung, and heart, and can quickly cause a life-threatening situation. Diaphragmatic hernias are diagnosed by: chest X-rays prenatal ultrasound noticeable breathing difficulty (respiratory distress) shortly after the baby’s birth.

An incision is made in the baby’s upper abdomen, under the ribs. The abdominal organs are gently pulled down through the opening in the diaphragm, and are positioned correctly inside of the abdominal cavity.

The hole in the baby’s diaphragm is repaired, and the incision is stitched closed. A tube is placed inside of his chest to allow air to flow, and blood and fluid to drain, so that the lung can re-expand.

The baby’s lung tissue might be underdeveloped on the affected side, and the outcome of this lung tissue depends upon its future development. Infants who survive surgery may have some long-term lung disease

Colon Diverticula

The colon, or large intestine, is a muscular tube that begins at the end of the small intestine and runs to the rectum. The colon absorbs water from liquid stool that is delivered to it from the small intestine.

Diverticula are out-pouchings of the wall of the colon. They are thought to be the result of a diet low in fiber. By the age of 60, over half of all Americans have colonic diverticula.

In most cases, diverticula go unnoticed. However, in a small percentage of patients, diverticula can cause problems. The most common problem is diverticulitis, which occurs when a small, hard piece of stool is trapped in the opening of the diverticula. This leads to inflammation and death of the segment of colon containing the diverticula.

Diverticula can also bleed and cause significant blood loss from the gastrointestinal tract. Vessels overlying a diverticula are stretched until they break, causing bleeding into the colon. Blood is usually passed in the stool.

Treatment of diverticulitis and diverticular bleeding involves surgical removal of the segment of colon containing the diverticula. While the patient is deep alseep and pain free (general anesthesia), an incision is made in the midline of the abdomen.

After the diseased area is removed, the healthy ends of the colon are sewn back together. Occasionally, especially in cases of diverticulitis, where there is significant inflammation, a colostomy is performed. After the inflammation has resided, the colostomy is removed and the healthy ends of the colon are sewn back together.

Colon Cancer

The colon, or large intestine, is a muscular tube that begins at the end of the small intestine and ends at the rectum. The colon absorbs water from liquid stool that is delivered to it from the small intestine.

Colon cancer is the third most common cancer in the United States. Risk factors include a diet low in fiber and high in fat, certain types of colonic polyps, inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), and certain hereditary disorders.

The treatment of colon cancer depends on the stage of the disease. Stage I cancer is limited to the inner lining of the colon; stage II cancer involves the entire wall of the colon; stage III cancer has spread to the lymph nodes; stage IV cancer has spread to other organs (metastasized). Surgery is the main treatment for colon cancer and removal of the involved colon is required. If the cancer is located near the rectum, a colostomy may be necessary. For stage I and II colon cancer, surgery is usually the only treatment. For stage III or IV colon cancer, chemotherapy is necessary after surgery. There is also some suggestion that chemotherapy may also be helpful in some selected stage II patients. Chemotherapy involves a course of drugs which are toxic to cancer cells. Stage I and II colon cancer have very high cure rates (60% to 90%); lower cure rates are seen with stage III and IV colon cancer. To detect colon cancer early, when it is most curable, everyone over the age of 55 should have bi-annual endoscopic examinations of the colon.

Breast Lump Removal

The female breast is composed of fatty tissue, interspersed with fibrous or connective tissue. The circular region around the nipple is often a different color or pigmentation. This region is called the areola.

Early detection of a breast lump is very important to your prognosis (probable outcome). Also, remember that most breast lumps are not diagnosed at the doctor’s office. They are detected by women who give themselves breast self-examinations at home. All breast lumps that persist beyond a few days must be reported to your doctor. In some cases, a needle aspiration of a breast lump can be performed. If the tissue obtained is clearly not cancerous (if blood wasn’t seen on the aspirator, or if the lump disappears after aspiration and does not recur), physicians will often simply observe patients. Otherwise, the breast lump must be removed surgically to determine if cancer is present.

A breast lump may either be a cyst filled with fluid or a solid mass of tissue. A sample of the breast tissue (biopsy) must be made to determine whether malignant (cancerous) cells are present. Almost two-thirds of all breast lumps are benign, but the chance of a malignant lump is greatly increased if you are past the age of menopause. While you are awake and pain-free (using local anesthesia) or asleep and pain-free (using general anesthesia), an incision is made over the lump. The incision for a lumpectomy is usually around 3 to 4 centimeters long. The incision will also depend on the size of the lump that needs to be removed. After the lump is removed in one piece, it is sent to the laboratory for immediate examination.

The outcome of the lumpectomy depends on the type of lump found. If the lump is benign (whether it is needle aspirated or excised), no further treatment is required. If the lump is malignant, the outcome depends on the degree to which the tumor has spread. Radiation therapy may be used in addition to surgery. In certain cases of malignant lumps, lumpectomy followed by radiation therapy is as effective as a radical mastectomy. Typically, lumpectomy does not require a breast replacement (prosthesis).

Appendectomy

The appendix is a small, finger-shaped pouch of intestinal tissue located between the small intestine (cecum) and large intestine (colon).

If the appendix becomes infected, it must be surgically removed before a hole develops and spreads the infection to the entire abdominal space. Symptoms of acute appendicitis include: abdominal pain (located in the lower right side) fever (elevated temperature) reduced appetite (anorexia) nausea (vomiting) Your doctor will: check the abdomen for tenderness and tightness check the rectum for tenderness and an enlarged appendix check the blood for an increase in white blood cells (WBC) perform a pelvic exam in women (to exclude pain caused by the ovaries or uterus) As of now, there isn’t a test to confirm appendicitis, and some of the symptoms may actually be caused by other illnesses. Your doctor will diagnose from the information you report, and from what he sees during your exam. Even if your doctor finds that the appendix is not infected (which can happen up to 25% of the time), he will thoroughly check the other abdominal organs and remove the appendix anyway.

A small incision is made in the lower right side of your abdomen, and the appendix is removed.

Appendectomy is performed while you are deep asleep and pain-free (using general anesthesia). If a pocket of infection (abscess) has formed or the appendix has ruptured (perforated), the abdomen will be thoroughly washed out during surgery. Your surgeon then leaves the skin open so it can mend together on its own (secondary intention), and so that the infection can drain (sometimes a small drainage tube is inserted). In some unusual cases, appendectomy can be performed laparoscopically. This is usually done in women, when the cause of the abdominal pain is uncertain.

Recovery from a simple appendectomy is usually complete and rapid. Most patients go home the day after their operation and resume a normal diet and normal activities within one to two weeks. If the appendix has developed an abscess or if it has ruptured, your recovery will be slower and more complicated, requiring use of medications (antibiotics) to treat the infection. Living without an appendix causes no known health problems.

Anal Fissure

The anus is a sphincter at the end of the rectum through which passes stool during defecation. The anal sphincter is a critical mechanism for control of fecal continence.

Anal fissures are tears in the skin overlying the anal sphincter, usually due to increased tone of the anal sphincter muscles, and a failure of these muscle to relax. Anal fissures cause pain during defecation and bleeding from the anus.

Most anal fissures can be treated successfully with conservative measures, which include stool softeners and warm soaks. The goal is to relax the anal sphincter, which allows the fissure to heal. If these methods are ineffective, surgery is necessary. This is called an internal sphincterotomy, a procedure in which the anal sphincter is partially cut, thus allowing it to relax and permitting the fissure to heal. Sphincterotomy, when properly performed, is very effective in healing anal fissures.